Critical care medicine
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Critical care medicine · Jul 1990
Comparative StudyAge and utilization of intensive care unit resources of critically ill cancer patients.
Older patients, patients with malignancies, and those admitted to ICUs utilize a disproportionate amount of hospital resources. To evaluate the combined impact of age and a diagnosis of malignancy on ICU utilization and outcome, we reviewed the care provided to all 1,212 patients admitted to a medical/surgical ICU in a hospital specializing in the treatment of cancer between January 1, 1986 and December 31, 1987. Patients between 19 and 64 yr (young) were compared with those between 65 and 74 yr (young-old) and with those greater than or equal to 75 yr (old-old) with respect to utilization of nutritional support (total parenteral nutrition [TPN]), mechanical ventilation (MV), pulmonary artery (PA) catheterization, dialysis (D), and blood products (B). ⋯ The ICU mortality of the two older groups was significantly lower than that of the younger patients (17%, 27%, and 30%, respectively). The use of TPN, PA catheters, and D was similar for all three groups, but older patients used less MV and B than the younger patients (p less than .0001, chi2 analysis). The two older groups also had similar LOS and lower average daily Therapeutic Intervention Scoring Systems (TISS) scores than their younger cohort.(ABSTRACT TRUNCATED AT 250 WORDS)
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Critical care medicine · Jul 1990
Prospective evaluation of a nonradiographic device for determination of endotracheal tube position in children.
A new noninvasive, nonradiographic endotracheal tube (ETT) position detection system (ETT-PDS) for guidance of ETT positioning was evaluated in pediatric ICU patients. The system includes an ETT with a metallic element embedded at a defined distance from the ETT tip, and a portable locator instrument which detects transcutaneously the position of the metallic element. ⋯ The ETT malposition rates observed on the postintubation chest radiographs were 39.1% after positioning guided by clinical assessment alone, and 19.6% after positioning guided by clinical assessment plus the ETT-PDS (p less than 0.5). This reduction in malnutrition rate could not be demonstrated when the ETT-PDS was used to guide routine ETT positioning performed before morning chest radiographs.
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Critical care medicine · Jul 1990
Comparative StudyComparative accuracy of pulse oximetry and transcutaneous oxygen in assessing arterial saturation in pediatric intensive care.
Recent improvements in the noninvasive measurement of oxygen saturation by pulse oximetry (SapO2) have resulted in the development of easily used bedside monitors. We compared the performance of the Biox 3700 and Nellcor N100E models against arterial saturation (SaO2) measured on a Radiometer OSM2 hemoximeter and against transcutaneous SO2 (StcO2) derived from transcutaneous oxygen tensions (PtcO2) (632, Roche Kontron). Twenty-four hemodynamically stable patients were studied, all with indwelling arterial lines, aged between 1 month and 13 yr. ⋯ The Biox machine generally read lower than the Nellcor with a mean difference of -1.63 +/- 2.65. SaO2 derived from PtcO2 (StcO2) did not differ significantly (-0.27 +/- 2.12) from SaO2. In hemodynamically stable infants and children, StcO2 and SapO2 have similar accuracy limits when compared with each other and with SaO2.
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Critical care medicine · Jul 1990
Dobutamine administration in septic shock: addition to a standard protocol.
Dobutamine administration has been shown to increase oxygen delivery in various conditions, but there are little data to document its effects in septic shock. We investigated the effects of dobutamine infusion at a rate of 5 micrograms/kg.min in 18 patients (mean 60 +/- 16 yr) with septic shock initially characterized by hypotension, oliguria, and hyperlactatemia in the presence of a documented source of sepsis. Early resuscitation had consisted of fluid administration and vasopressors when required. ⋯ Oxygen consumption (VO2) increased concurrently (from 137 +/- 42 to 162 +/- 66 ml/min.m2, p less than .002). MAP increased (from 68 +/- 9 to 76 +/- 11 mm Hg) in 12 patients and decreased moderately (from 76 +/- 18 to 69 +/- 17 mm Hg) in six patients. The two subgroups of patients had similar hemodynamic profiles before the dobutamine infusion, but vasopressor therapy was already used in one of the 12 patients in the first subgroup and in three of the six patients in the second subgroup (p less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)
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The incidence and consequences of fluid overload in the surgical ICU (SICU) have not been well defined, but may influence length of stay, days requiring mechanical ventilation, and mortality. Forty-eight consecutive patients admitted to our SICU were prospectively monitored for acute changes in weight and its impact on clinical management and outcome. When defined as a gain greater than 10% from their preoperative or premorbid weight (or an approximately 20% increase in total body water), 40% of patients had fluid overload. ⋯ When indexed by initial Acute Physiology and Chronic Health Evaluation (APACHE II) mortality prediction scores, all groups had similar degrees of illness. On average, presumably due to volume limitations, patients were inadequately nourished during 85% of their SICU stay. Our results suggest that the morbidity of fluid overload can be significant, and warrants a fresh look at the methods of intraoperative fluid resuscitation.